Clinical investigation and imaging

Abstract

Adolescent idiopathic scoliosis (AIS) affects 2-4 % of children and is diagnosed between age 10 and skeletal maturity. The female to male ratio for mild curves less than 20°is 1.5:1; however, progression to a severe deformity occurs more often in females (Weinstein in JAMA 289(5): [559][560][561][562][563][564][565][566][567] 2003). Despite significant ongoing research, including into the genetic basis for AIS, there are currently no identifiable causes, and therefore the disorder still remains a diagnosis of exclusion. History, physical examination and radiographic assessment must exclude other possible causes of spinal deformity and are crucial in predicting the risk of curve progression. History should focus on family history, menarche, presence or absence of pain, sports activities and neurologic changes. Physical examination concentrates on anthropometric data, pubertal staging, neurologic testing and specific investigation of the spine, with the Adams' forward bending test being the most meaningful step to evaluate trunk rotation. Definitive diagnosis cannot be made without imaging. The gold standard remains plain radiography with assessment of the Cobb angle on a standing coronal radiograph of the entire spine. A lateral X-ray is used for assessing sagittal balance and for evaluating the deformity in the sagittal plane. If available, surface topography can accompany the followup in AIS, reducing the radiation exposure. The role of magnetic resonance imaging (MRI) in AIS is an ongoing matter of debate. Common indications for MRI are the presence of an atypical curve pattern and abnormal neurological findings. Keywords Adolescent idiopathic scoliosis Á Patient's history Á Clinical investigation Á Imaging Clinical investigation Medical historyEvaluation of a child with scoliosis should begin with a comprehensive and complete medical history focused on family history of scoliosis, complaints of pain, neurologic signs or symptoms, including bowel and bladder dysfunction, information on physical development and sports activities.Family history AIS is often seen in multiple members of one family, strongly suggesting a genetic component. A meta-analysis of studies of twins showed concordance for AIS in 73 % of monozygotic and 36 % of dizygotic twins [2]. A recent study confirmed the genetic etiology in AIS, but with a concordance being much lower [3]. Current research is focusing on identifying the multiple responsible genes that cause AIS and that probably play an important role in determining the risk of curve progression. In 2010 a DNAbased test (ScoliScore, Axial Biotech, Salt Lake City, USA) to predict spinal curve progression in AIS was presented and validated [4]. This promising tool will probably revolutionize future concepts of AIS treatment but so far it is applicable only to Caucasian females and males between ages 9-13 which have already been diagnosed with mild scoliosis (10-25°Cobb angle).

Using Skin Markers for Spinal Curvature Quantification in Main Thoracic Adolescent Idiopathic Scoliosis: An Explorative Radiographic Study

“…Radiographic images were processed using the software ImageJ (version 1.47, U. S. National Institutes of Health, Bethesda, MD, USA). Cobb-angles were determined as described in the literature [ 30 ]. The centers of area (CoA) of the vertebral bodies and the markers in both planes as well as the spinous processes in the frontal plane were calculated based on their manually identified shapes ( Fig 1A and 1B ).…”

Decreased Vertical Trunk Inclination Angle and Pelvic Inclination as the Result of Mid-High-Heeled Footwear on Static Posture Parameters in Asymptomatic Young Adult Women

“…The limitations of comparison of the radiographic with surface topography studies are concerned in the measures and indexes [88,103,107]. The only trend of observed changes can be compared to some extent.…”

Comparison of spinal curvature parameters as determined by the ZEBRIS spine examination method and the Cobb method in children with scoliosis

“…Biplanar X-ray images were processed using the software ImageJ (version 1.54). Cobb angles such as thoracic kyphosis ( RTG_TK ), lumbar lordosis ( RTG_LL ) in the sagittal plane, thoracic curvature ( RTG_TSC ) and thoracolumbar/lumbar curvatures ( RTG_LSC ) in the frontal plane were determined as described in the literature [ 56 ]. The test-retest reliability of the determination of Cobb angles with software on X-rays had been analysed by several researchers [ 57 – 59 ].…”